Aspergillosis

Overview

Aspergillosis is an infection caused by a type of mold (fungus) called aspergillus. The illnesses resulting from aspergillosis infection usually affect the respiratory system, but their signs and severity vary greatly. The mold that triggers the illnesses is found both indoors and outdoors, with most strains being harmless. However, a few strains can cause serious illnesses when people with weakened immune systems, underlying lung disease, or asthma inhale their fungal spores. In some people, the spores trigger an allergic reaction, while others develop mild to severe lung infections. The most severe form of aspergillosis is invasive aspergillosis, which occurs when the infection spreads to blood vessels and beyond. Treatment options include observation, antifungal medications, or, in rare cases, surgery. The signs and symptoms of aspergillosis vary depending on the type of illness, ranging from allergic reactions to invasive forms that can be life-threatening.

Understanding the disease

Symptoms

The symptoms of aspergillosis vary depending on the type of illness. For allergic reaction to aspergillus mold, symptoms include: cough that often brings up blood (hemoptysis), wheezing, shortness of breath, unintentional weight loss, and fatigue. For invasive aspergillosis, the most severe form of the infection, symptoms depend on which organs are affected, but may include fever and chills, a cough that brings up blood, shortness of breath, chest or joint pain, headaches or eye symptoms, and skin lesions. Other types of aspergillosis may cause a stuffy nose with drainage that may contain blood, fever, facial pain, and headache. If you have asthma or cystic fibrosis, or have a weakened immune system, it's important to seek medical attention for any change in breathing or unexplained fever, shortness of breath, or cough that brings up blood.

Risk Factors

The risk factors for developing aspergillosis are:

1. Weakened immune system: People who have undergone bone marrow or stem cell transplants, have certain cancers of the blood, or are in the later stages of AIDS are at highest risk of invasive aspergillosis.
2. Low white blood cell level: Individuals who have had chemotherapy, organ transplants, or leukemia, or have chronic granulomatous disease are more susceptible to invasive aspergillosis.
3. Lung cavities: People with air spaces (cavities) in their lungs are at higher risk of developing aspergillomas.
4. Asthma or cystic fibrosis: People with these conditions, especially those with long-standing or difficult-to-control lung problems, are more likely to have an allergic response to aspergillus mold. It is important to note that exposure to aspergillus mold is unavoidable, but healthy individuals with strong immune systems usually do not develop aspergillosis. If you have asthma or cystic fibrosis and notice a change in your breathing, or if you have a weakened immune system and experience unexplained fever, shortness of breath, or a cough that brings up blood, it is crucial to seek immediate medical care.

Development

Aspergillosis can develop in different ways, depending on the type of illness:

1. Allergic reaction: Some people with asthma or cystic fibrosis have an allergic reaction to aspergillus mold, leading to allergic bronchopulmonary aspergillosis. Symptoms include coughing, wheezing, shortness of breath, unintentional weight loss, and fatigue.
2. Invasive aspergillosis: This is the most severe form of aspergillosis, occurring when the infection spreads rapidly from the lungs to other organs such as the brain, heart, kidneys, or skin. It is more likely to develop in people with weakened immune systems due to cancer chemotherapy, bone marrow transplantation, or diseases of the immune system. Untreated, invasive aspergillosis can be fatal. Symptoms may include fever, chills, coughing, shortness of breath, chest or joint pain, headaches, eye symptoms, and skin lesions.
3. Aspergilloma: Certain chronic lung conditions, such as emphysema, tuberculosis, or advanced sarcoidosis, can cause air spaces (cavities) in the lungs. When people with lung cavities are also infected with aspergillus, fungus fibers can grow into tangled masses (fungus balls) known as aspergillomas. Aspergillomas may not cause symptoms initially, but over time, they can worsen the underlying chronic lung condition and cause coughing, wheezing, shortness of breath, unintentional weight loss, and fatigue. The development of aspergillosis is influenced by factors such as a weakened immune system, underlying lung diseases, and exposure to aspergillus mold.

Assessment and Diagnosis

Triage

If you have a weakened immune system and develop an unexplained fever, shortness of breath, or a cough that brings up blood, you should seek immediate medical care when aspergillosis is suspected. Prompt treatment is crucial, especially in cases of invasive aspergillosis, as it can be life-threatening if left untreated. Your doctor may begin treatment with antifungal medications even before the diagnosis is confirmed to ensure effective management of the infection.

Diagnosis

To diagnose aspergillosis, your doctor will likely use a combination of tests, including imaging tests, respiratory secretion tests, tissue and blood tests, and in some cases, a biopsy. Imaging tests such as chest X-rays or CT scans can reveal a fungal mass or characteristic signs of invasive aspergillosis. Respiratory secretion tests involve examining a sample of your sputum for the presence of aspergillus filaments, while tissue and blood tests can help confirm allergic bronchopulmonary aspergillosis. A biopsy may be necessary in some cases to confirm a diagnosis of invasive aspergillosis.

Management and Treatment

Complications

Potential complications of aspergillosis include bleeding, both aspergillomas and invasive aspergillosis can cause severe, and sometimes fatal, bleeding in your lungs. Another serious complication is the spread of the infection to other parts of your body, especially your brain, heart, and kidneys. Invasive aspergillosis spreads rapidly and may be fatal.

Prevention

regarding the prevention of aspergillosis.

Treatment

Treatment for aspergillosis depends on the type of illness and its severity. The following treatments may be used:

1. Observation: For some cases of allergic reaction to aspergillus mold, no treatment may be necessary. The symptoms may resolve on their own, and the person may just need to avoid exposure to the mold.
2. Antifungal medications: For allergic bronchopulmonary aspergillosis and other mild to moderate forms of aspergillosis, antifungal medications may be prescribed. These drugs can help reduce inflammation and clear up the infection.
3. Surgery: In rare cases, invasive aspergillosis may require surgical intervention to remove infected tissue or to stop bleeding. It's important to note that long-term use of corticosteroids, which are often used to treat underlying diseases, may increase the risk of opportunistic infections, including aspergillosis. Consult a healthcare professional for personalized advice on managing aspergillosis and its potential complications.

Preparing for medical consultation

To prepare for an appointment for aspergillosis, you should:

1. Be aware of any pre- or post-appointment restrictions: When you call for the appointment, ask if there's anything you need to do in advance.
2. Write down key medical information: Make a list of your other